Provider Demographics
NPI:1215946462
Name:KENNEY, SARA KATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHERINE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 N LARCHMONT BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1306
Mailing Address - Country:US
Mailing Address - Phone:323-692-9003
Mailing Address - Fax:323-465-2025
Practice Address - Street 1:588 N LARCHMONT BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1306
Practice Address - Country:US
Practice Address - Phone:323-692-9003
Practice Address - Fax:323-465-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS200601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical